Patient Support - Prior Authorization Specialist

Job Title:Prior Authorization Specialist
Weekly Hours: Full-Time, 40 hours/week
Supervised by:Manager, Business Operations
Location: Pelham Place, In Person

Overview:Responsible for managing prior authorizations forParkside OB-GYN, including, surgeries, medications, diagnostic imaging, andobstetriccare. Initiating prior authorizations when orders are placedor upon requestfrom specialty offices, pharmacies, or patients. Communicating with patientsby phone regarding the status of their authorizations and collaborating closely with the referrals, surgery scheduling, administrative, and clinical teams to ensure all authorizations are completed accurately and efficiently.

Responsibilities:

1. Initiating, creating,and facilitating the prior authorization process for surgeries, c-sections, obstetrical care, medications, and diagnostic imaging.

1. Initiating, creating, and facilitating Medicaid pregnancy notifications and Medicaid sterilization consents.

1. Responding to any telephone encounter or patient message requests for prior authorization and communicating with the ordering provider as necessary.

1. Communicating updates regarding PAs with patients as necessary and returning phone calls from patients with questions about their prior authorization.

1. Other duties as assigned.

1. Takes ownership of ensuring the “Tribe Way” is experienced by patients, families, and team members. Promotes an authentic, transparent work environment within all areas.

Required Education & Certifications:

• Minimum education requirement: High School Diploma or GED.

• Minimum of 1 year of experience working inthe medical field. Experience facilitating prior authorizations preferred.

• Excellent interpersonal and communication (oral and written) skills with customer service focus required.

• Expert computer skills and typing.

Work environment and Physical Demands: 

Requires sitting, standing, and walking associated with a normal physician office environment. Person may be exposed to fumes, airborne particles, infectious diseases, blood/bodily fluids, and disease-bearing specimens. 

Tribe 513 is an Equal Opportunity Employer